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NSG 3130 Exam 4 Study Guide
2026/2027 | Fundamental
Concepts & Skills II | Galen
College
Prepare for NSG 3130 Exam 4 with 100 multiple-choice
questions and detailed rationales covering heart failure,
COPD, chest tubes, tracheostomy care, cardiac
catheterization, digoxin and diuretic monitoring,
perioperative nursing, grief and end-of-life care,
medication safety, and pressure injury staging. Aligned
with Galen College of Nursing Fundamental Concepts &
Skills for Nursing Practice II, 2026/2027. Review
cardiovascular, respiratory, and safety concepts to
strengthen clinical reasoning and exam readiness.
1. A nurse is assessing a client with left-sided heart failure. Which finding
should the nurse expect?
A. Jugular venous distention
B. Peripheral edema
C. Crackles in the lung bases
D. Hepatomegaly
Answer: C. Crackles in the lung bases
,2|Page
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
circulation, leading to pulmonary congestion. Crackles, orthopnea, and dyspnea
are classic signs. JVD, peripheral edema, and hepatomegaly are signs of right-
sided heart failure.
2. A client with right-sided heart failure is most at risk for which complication?
A. Pulmonary edema
B. Dependent edema
C. Orthopnea
D. Paroxysmal nocturnal dyspnea
Answer: B. Dependent edema
Rationale: Right-sided heart failure causes systemic venous congestion, leading
to dependent edema, JVD, and hepatomegaly. Pulmonary edema, orthopnea,
and PND are associated with left-sided failure.
3. A nurse is caring for a client taking digoxin. Which serum potassium level
places the client at highest risk for digoxin toxicity?
A. 5.2 mEq/L
B. 4.0 mEq/L
C. 3.2 mEq/L
D. 4.8 mEq/L
Answer: C. 3.2 mEq/L
Rationale: Hypokalemia increases the risk of digoxin toxicity because digoxin
and potassium compete for the same binding sites. A potassium level below 3.5
mEq/L places the client at risk. Normal range is 3.5–5.0 mEq/L.
4. A client is scheduled for a cardiac catheterization. Which assessment is the
priority post-procedure?
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A. Monitor urine output
B. Assess distal pulses in the affected extremity
C. Check blood glucose
D. Auscultate bowel sounds
Answer: B. Assess distal pulses in the affected extremity
Rationale: The priority after cardiac catheterization is monitoring for arterial
complications such as bleeding, hematoma, or occlusion. Assessing distal
pulses, color, temperature, and sensation ensures adequate perfusion to the
extremity.
5. A nurse is teaching a client about a low-sodium diet for heart failure. Which
statement indicates understanding?
A. "I can use salt substitutes freely."
B. "I should read food labels for sodium content."
C. "Canned soups are fine if I drain the liquid."
D. "I only need to limit salt when I feel short of breath."
Answer: B. "I should read food labels for sodium content."
Rationale: Reading labels helps identify hidden sodium in processed foods. Salt
substitutes often contain potassium, which can be dangerous with certain
medications. Canned soups are high in sodium even when drained. Sodium
restriction is a daily lifelong management strategy, not just during
exacerbations.
6. A client with COPD has an oxygen saturation of 86%. Which oxygen delivery
device should the nurse anticipate?
A. Nasal cannula at 6 L/min
B. Simple face mask at 10 L/min
C. Venturi mask at 2 L/min
D. Non-rebreather mask at 15 L/min
Answer: C. Venturi mask at 2 L/min
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Rationale: Clients with COPD are at risk for CO2 retention. A Venturi mask
delivers precise, controlled low concentrations of oxygen (24–40%), making it
the safest choice. High-flow oxygen can suppress the hypoxic drive in COPD
clients.
7. A nurse is caring for a client with a tracheostomy. Which action is correct
when changing the tracheostomy ties?
A. Remove old ties before securing new ones
B. Have an assistant hold the trach tube while changing ties
C. Change ties only when the stoma is infected
D. Tighten ties so two fingers fit under them
Answer: B. Have an assistant hold the trach tube while changing ties
Rationale: The priority is preventing accidental decannulation. A second person
should hold the trach tube in place while the ties are changed. The old ties
should remain until new ones are secured. Two fingers should fit under the ties
to prevent pressure injury.
8. A nurse is suctioning a client's airway. Which action is appropriate?
A. Suction for 20 seconds per pass
B. Hyperoxygenate before suctioning
C. Use the largest catheter available
D. Apply suction while inserting the catheter
Answer: B. Hyperoxygenate before suctioning
Rationale: Hyperoxygenation before suctioning prevents hypoxemia. Suction
should be limited to 10–15 seconds per pass. The catheter should be no more
than half the diameter of the airway. Suction is applied only during withdrawal,
not insertion.
9. A client with a chest tube develops subcutaneous emphysema. What is the
nurse's priority action?
NSG 3130 Exam 4 Study Guide
2026/2027 | Fundamental
Concepts & Skills II | Galen
College
Prepare for NSG 3130 Exam 4 with 100 multiple-choice
questions and detailed rationales covering heart failure,
COPD, chest tubes, tracheostomy care, cardiac
catheterization, digoxin and diuretic monitoring,
perioperative nursing, grief and end-of-life care,
medication safety, and pressure injury staging. Aligned
with Galen College of Nursing Fundamental Concepts &
Skills for Nursing Practice II, 2026/2027. Review
cardiovascular, respiratory, and safety concepts to
strengthen clinical reasoning and exam readiness.
1. A nurse is assessing a client with left-sided heart failure. Which finding
should the nurse expect?
A. Jugular venous distention
B. Peripheral edema
C. Crackles in the lung bases
D. Hepatomegaly
Answer: C. Crackles in the lung bases
,2|Page
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
circulation, leading to pulmonary congestion. Crackles, orthopnea, and dyspnea
are classic signs. JVD, peripheral edema, and hepatomegaly are signs of right-
sided heart failure.
2. A client with right-sided heart failure is most at risk for which complication?
A. Pulmonary edema
B. Dependent edema
C. Orthopnea
D. Paroxysmal nocturnal dyspnea
Answer: B. Dependent edema
Rationale: Right-sided heart failure causes systemic venous congestion, leading
to dependent edema, JVD, and hepatomegaly. Pulmonary edema, orthopnea,
and PND are associated with left-sided failure.
3. A nurse is caring for a client taking digoxin. Which serum potassium level
places the client at highest risk for digoxin toxicity?
A. 5.2 mEq/L
B. 4.0 mEq/L
C. 3.2 mEq/L
D. 4.8 mEq/L
Answer: C. 3.2 mEq/L
Rationale: Hypokalemia increases the risk of digoxin toxicity because digoxin
and potassium compete for the same binding sites. A potassium level below 3.5
mEq/L places the client at risk. Normal range is 3.5–5.0 mEq/L.
4. A client is scheduled for a cardiac catheterization. Which assessment is the
priority post-procedure?
,3|Page
A. Monitor urine output
B. Assess distal pulses in the affected extremity
C. Check blood glucose
D. Auscultate bowel sounds
Answer: B. Assess distal pulses in the affected extremity
Rationale: The priority after cardiac catheterization is monitoring for arterial
complications such as bleeding, hematoma, or occlusion. Assessing distal
pulses, color, temperature, and sensation ensures adequate perfusion to the
extremity.
5. A nurse is teaching a client about a low-sodium diet for heart failure. Which
statement indicates understanding?
A. "I can use salt substitutes freely."
B. "I should read food labels for sodium content."
C. "Canned soups are fine if I drain the liquid."
D. "I only need to limit salt when I feel short of breath."
Answer: B. "I should read food labels for sodium content."
Rationale: Reading labels helps identify hidden sodium in processed foods. Salt
substitutes often contain potassium, which can be dangerous with certain
medications. Canned soups are high in sodium even when drained. Sodium
restriction is a daily lifelong management strategy, not just during
exacerbations.
6. A client with COPD has an oxygen saturation of 86%. Which oxygen delivery
device should the nurse anticipate?
A. Nasal cannula at 6 L/min
B. Simple face mask at 10 L/min
C. Venturi mask at 2 L/min
D. Non-rebreather mask at 15 L/min
Answer: C. Venturi mask at 2 L/min
, 4|Page
Rationale: Clients with COPD are at risk for CO2 retention. A Venturi mask
delivers precise, controlled low concentrations of oxygen (24–40%), making it
the safest choice. High-flow oxygen can suppress the hypoxic drive in COPD
clients.
7. A nurse is caring for a client with a tracheostomy. Which action is correct
when changing the tracheostomy ties?
A. Remove old ties before securing new ones
B. Have an assistant hold the trach tube while changing ties
C. Change ties only when the stoma is infected
D. Tighten ties so two fingers fit under them
Answer: B. Have an assistant hold the trach tube while changing ties
Rationale: The priority is preventing accidental decannulation. A second person
should hold the trach tube in place while the ties are changed. The old ties
should remain until new ones are secured. Two fingers should fit under the ties
to prevent pressure injury.
8. A nurse is suctioning a client's airway. Which action is appropriate?
A. Suction for 20 seconds per pass
B. Hyperoxygenate before suctioning
C. Use the largest catheter available
D. Apply suction while inserting the catheter
Answer: B. Hyperoxygenate before suctioning
Rationale: Hyperoxygenation before suctioning prevents hypoxemia. Suction
should be limited to 10–15 seconds per pass. The catheter should be no more
than half the diameter of the airway. Suction is applied only during withdrawal,
not insertion.
9. A client with a chest tube develops subcutaneous emphysema. What is the
nurse's priority action?
